Hello Dr. Foster,
My daughter was diagnosed with JRA when she was 2 yrs old. She is ANA positive and has had flares in her left eye off and on. She is almost 10 now. She is always treated with Pred Forte for a period of time, the dose slowly tapered, and she is sometimes without a flare for quite some time. She even went over a year without a flare. She is on Methotrexate 15 mg. sq weekly to control her inflammation in her knees and ankles and mostly for her eyes. She has had several joint injections which have helped. This go around, the Pred Forte and Cyclogyl does not seem to be working. Her Rheumatologist suggested Remicade which I would llike to avoid if at all possible. I have discussed a sub tenon injection with her Ophthalmologist and she said she would give it a try but it would probably only be a temporary aid. I am not sure if she would use Kenalog or Decadron. I am a COA with 18 years experience in Ophthalmology and realize the importance of getting her condition under control. A retina specialist I used to work with suggested a combination of Pred Forte mixed with a non-steroidal such as Voltaren or Acular, and to change the Cyclogyl to Atropine bid. Another option that was mentioned would be a Medrol Dose pack to see if that would quiet the inflammation. She always has her flares in the left eye only for some reason and her va is 20/20 ou. She has a trace PSC, but not all docs agree so it must be minimal. She has a small area of band keratopathy in the os as well. I know it is difficult without seeing her but any thoughts???
My daughter was diagnosed with JRA when she was 2 yrs old. She is ANA positive and has had flares in her left eye off and on. She is almost 10 now. She is always treated with Pred Forte for a period of time, the dose slowly tapered, and she is sometimes without a flare for quite some time. She even went over a year without a flare. She is on Methotrexate 15 mg. sq weekly to control her inflammation in her knees and ankles and mostly for her eyes. She has had several joint injections which have helped. This go around, the Pred Forte and Cyclogyl does not seem to be working. Her Rheumatologist suggested Remicade which I would llike to avoid if at all possible. I have discussed a sub tenon injection with her Ophthalmologist and she said she would give it a try but it would probably only be a temporary aid. I am not sure if she would use Kenalog or Decadron. I am a COA with 18 years experience in Ophthalmology and realize the importance of getting her condition under control. A retina specialist I used to work with suggested a combination of Pred Forte mixed with a non-steroidal such as Voltaren or Acular, and to change the Cyclogyl to Atropine bid. Another option that was mentioned would be a Medrol Dose pack to see if that would quiet the inflammation. She always has her flares in the left eye only for some reason and her va is 20/20 ou. She has a trace PSC, but not all docs agree so it must be minimal. She has a small area of band keratopathy in the os as well. I know it is difficult without seeing her but any thoughts???
